Unit 2

Unit II- PRIMARY HEALTH CARE
BY
SEHRISH NAZ & RABIA LOHANI
RN, Post RN, MSN
Lecturer, Institute of Nursing Sciences,
Khyber Medical University
Subject: Community Health Nursing
credit hour: 2+1=3
1Generic BSN semester II

Objectives
• At the completion of this unit, students will be
able to:
• 1 Explain Alma Atta Deceleration “Health for All
by the Year 2000” and beyond.
• 3. Define Primary care and Primary Health Care.
• 4. Describe the five basic principle of PHC
• 5. Explain the elements of PHC in relation to
health
• 6. Discuss application of PHC in Pakistan

INTRODUCTION TO HEALTH CARE
• Health - fundamental human right
• Integrated care comprising preventive,
promotive, curative & rehabilitation services
• Extending from “womb to tomb”
• Key to socio economic development and
progress of the country
• Organized in three levels

TERTIARY
LEVEL
SECONDARY
LEVEL
PRIMARY
LEVEL
HEALTH CARE PYRAMID

EVOLUTION OF PRIMARY HEALTH
CARE
The Alma-Ata Conference
• International conference on primary health care
• Conducted from 6-12th September 1978 at Alma Ata
• Mile stone in the history of public health
• Key to the attainment of the goal of the Health for All

OBJECTIVES OF ALMA-ATA
• To promote the concept of primary health care
• To evaluate the present health care situation
• To define the principles of primary health care
• To define the roles of governmental, national and international
organisations
• To formulate recommendations for the development

DECLARATION OF ALMA-ATA
• Existing gross inequality in the health status of
the people is unacceptable
• People have a right and duty in participating
individually and collectively
• Primary health care is essential health care
• An acceptable level of health for all the people
by 2000

DEFINITION
Primary health care -“an essential health care made
universally accessible to individuals and acceptable
to them, through their full participation and at a cost
the community and country can afford to maintain at
every stage of their development in the spirit of self
reliance and self determination.” (alma ata)

ATTRIBUTES OF PRIMARY HEALTH
CARE
• Essential health care
• Universally accessible
• Acceptable
• Community based
• First point of contact
• Affordability

ATTRIBUTES Contd...
• Adaptability
• Appropriateness
• Community participation
• Continuity
• Comprehensiveness
• Coordination

ATTRIBUTES contd...
Accessible
Affordable
Primary health care
Acceptable
Appropriate
Adaptable

The Basic Requirements for Sound PHC (the
8 A’s and the 3 C’s)
• Appropriateness
• Availability
• Adequacy
• Accessibility
• Acceptability
• Affordability
• Assessability
• Accountability
• Completeness
• Comprehensiveness
• Continuity

COMPONENTS OF PRIMARY HEALTH
CARE
• Education concerning the prevailing health problems
and the methods of preventing and controlling them
• Promotion of food supply and proper nutrition
• Adequate supply of safe water and basic sanitation
• Maternal and child health care including family
planning
• Immunization against major infectious diseases
• Prevention and control of locally endemic diseases

COMPONENTS OF PRIMARY HEALTH
CARE
• Appropriate treatment of common diseases and
injuries
• Provision of essential drugs
• Training of health guides, health workers and health
assistants
• Referral services
• Mental health
• Physical handicaps
• Health and social care of the elderly

.
Primary Health Care
Preventive services Curative services
General services Care of vulnerable groups
Outpatient clinic (referral)
Laboratory services
Dispensary
First aid and emergency
services
Health education
Monitoring of environment
Prevent &control of
endemic diseases
Health office services
Maternal & child health
School health services
Geriatric health services
Occupational health services

PRINCIPLES OF PRIMARY HEALTH
CARE
 Equitable distribution
 Community participation
 Intersectoral coordination
 Appropriate technology

EQUITABLE DISTRIBUTION
• Inequity in the availability of health
services - major concern
• Supply of health care resources- more towards affluent areas
• Julian Tudor Hart - “Inverse Care Law”
Availability of good medical care tends to vary inversely with
the need for it in the population served

• First key principle in the primary health care
• Ensures that individuals with more compromised health
conditions will receive more health services
• Commitment to health equity focuses not only on ensuring
program inputs but also reducing differences in health
outcomes.

• Access to health care - horizontal equity & vertical equity
• Horizontal equity - “equal access for equal needs”
 equal resources
 equal access to health care
 equal utilization of health services
 equal health

• Vertical equity - unequal should be treated in proportion of
their inequality
• Individuals with more need should have more treatment
• The central theme of “need” therefore determines equity

COMMUNITY PARTICIPATION
• Involvement of the individuals, families and community
• Determines both collective needs and priorities
• Important role in formulating a health problem, make informed
choices ,objectives with community priorities
• Universal coverage cannot be achieved without the involvement
of the local community

Advantages of community participation:
• Increases program acceptance and
leadership
• Ensures that the program meets the local needs
• Cost of implementing the program may be reduced by using
the local resources
• Uses local/ familiar organizations and hence problem solving
is efficient
• Commitments to the decision is facilitated
• Key to the sustainability

Planning steps in community participation
Identification and prioritization of the problems
Planning together
Implementation by community members
Evaluation by community members

Examples of community participation.
• Village health guides, trained dais,
• Selected by the local community and trained locally
• Essential feature of health care

Village Health and Sanitation Committee
• Play multiple roles including household surveys,
preparation of health registers, organisation of
meetings at the village level, promoting household
toilet, sanitation programme.

INTERSECTORAL CO-ORDINATION
• “Primary care involves in addition to the health sector, all related
sectors and aspects of national and community development”
• Includes sustainable participation that combine inter-
organizational cooperative working alliances.
• Possibly, but not necessarily,
in collaboration with
the health sector

Pre-requisites for Intersectoral Coordination:
• Proper orientation of policies and programme
• Formation of joint coordination committee at each level
• Defining role and responsibilities of participatory agencies
• Participatory decision making

Intersectoral Co-ordination
• Developing formal system of interaction, discussion and
debate
• Sharing of the problems faced in implementation
• Spelling out strategies and procedure
• Joint evaluation and monitoring

Mechanism of co-ordination:
• List out names of different sectors
• Identify the NGOs and voluntary organisation
• Constitute the district level co-ordination committee
• Formulate specific task forces
• Jointly decide the objectives and areas
• Decide the role and responsibility
• Development a plan

Difficulties facing intersectoral co-ordination:
• Create conflicts of interest and disequilibrium
• Power struggles
• Agencies must be able to compromise and impose change on
the normal working patterns
• Cultural changes may occur within organisations
• Co-ordination may turn out to be more expensive in terms of
time, money and manpower

• Irrespective of the disadvantages, intersectoral coordination is
the key principle outlined by WHO if Health for All has to be
achieved

APPROPRIATE TECHNOLOGY
• “Technology that is scientifically sound, adaptable to local
needs and acceptable to those who apply it and those for
whom it is used and is maintained by the people themselves in
keeping with the principle of self reliance with the resources
the country and the community can afford”

Appropriate Technology
• Designed to meet specific health needs
• Criteria for choosing which needs should be addressed -
include magnitude of the population affected, the degree of
morbidity or mortality caused by the health condition
• Lack of solutions that are effective, safe, acceptable,
affordable, accessible, and sustainable

An appropriate technology should be: (WHO-1989)
• Scientifically valid
• Adapted to local needs
• Acceptable to users and recipients
• Maintainable with local resources

Technology only effective if accompanied
by...
• Knowledgeable and skilled users
• Clear practice guidelines and policies
• Effective financing and distribution to make
them available
• Community efforts to bring clients into contact
with health services in timely way

• Only have impact if incorporated into a
comprehensive health delivery system
• Defining the attributes and characteristics of
appropriate health technologies needs to take place
early

Examples for the appropriate technology
• Use of coloured tapes for measuring mid upper arm
circumference
• Use of ORS
• Tender coconut for oral hydration
• Growth chart maintenance for under five children

• Informational technological advancements that have been
proven to ultimately enhancing the service delivery-
 Health Management Information System

REFERENCES
1. Programme Management. National Institute of Health and
Family Welfare. New Delhi (India): 2013.p.45-58
2. Primary Health care- Indian scenario. World Health organization
[online] 2008 Aug [cited on 2015 Jan 31]; Available
from:URL:http://who.int/health_care_documents/phc -Indian
scenario.pdf
3. .Rahim A. Principles and Practice of Community Medicine. 1st
ed. New Delhi(India): Jaypee Brothers medical publishers(P)
Ltd; 2008.p.23-33

“When we talk about capacity, we absolutely must talk about the
importance of primary health care. It is the cornerstone of building
the capacity of health systems”
- Dr. Margaret chan
director, Director general
WHO
THANK YOU

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